Reply: “Could Noninvasive Ventilation Failure Rates Be Underestimated in the LUNG SAFE Study?” and “High-Flow Oxygen, Positive End-Expiratory Pressure, and the Berlin Definition of Acute Respiratory Distress Syndrome: Are They Mutually Exclusive?”

Introduction. The prognosis of mycoplasma pneumonia in adults is generally favorable, but a few patients show progression to acute respiratory distress syndrome (ARDS). We have described the management of a patient who showed progression of mycoplasma pneumonia to ARDS. Presentation of Case. A 26-year-old male patient with no significant past medical or social history presented with a 5-day history of fever. Following this, he was diagnosed with bacterial pneumonia and treated with tazobactam/piperacillin; however, he showed little clinical improvement with this treatment approach. We diagnosed the patient with mycoplasma pneumonia with an antigen test and treated him with azithromycin and prednisolone. Despite the appropriate antimicrobial therapy, his symptoms worsened and therefore we changed his oxygen therapy from a reservoir mask to nasal high-flow oxygen in addition to minocycline. Consequently, with this treatment, he recovered from severe mycoplasma pneumonia. Discussion. In patients with severe pneumonia who experience respiratory failure, it has been reported that nasal high-flow oxygen therapy is not inferior to noninvasive positive pressure ventilation therapy regarding intubation rate. In this case, induction of nasal high-flow oxygen therapy led to avoidance of ventilator management. This is a valuable case report highlighting the optimal outcome of nasal high-flow oxygen therapy in a fulminant case of acute respiratory distress syndrome. Conclusion. In patients who present with severe mycoplasma pneumonia with respiratory failure, nasal high-flow oxygen therapy can help reduce the needs for ventilator management including intubation.

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Definition of Acute Respiratory Distress Syndrome in Plateau of Xining,Qinghai: Verification of Berlin Definition Plateau Criteria

10.21203/rs.3.rs-88294/v1 ◽

2020 ◽

Author(s):

Xiaoqin Liu ◽

Chun Pan ◽

Li-Ning Si ◽

Shijun Tong ◽

Yi Niu ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

High Altitude ◽

Distress Syndrome ◽

Great Influence ◽

Oxygenation Index ◽

Berlin Definition ◽

Hypoxic Environment ◽

Definition Of

Abstract Background Acute respiratory distress syndrome（ARDS） is a common respiratory critical illness. The high altitude hypoxic environment has a great influence on its occurrence and development. Now we lack clear diagnostic definition of high altitude acute respiratory distress syndrome.To verify the application value of Berlin Definition plateau criteria of Acute Respiratory Distress Syndrome in Xining , Qinghai ( 2261m).Methods Retrospective analysis of the clinical data of ARDS patients admitted to the Department of Critical Care Medicine of the Affiliated Hospital of Qinghai University from January 2018 to December 2018. The severity was divided according to the Berlin definition, the plateau standard, and the Zhang standard, and the differences of three standards were compared.Results In this study, 512 patients with mechanical ventilation were selected. 229 patients who met the criteria of Berlin Definition plateau criteria , including 107 patients with mild ARDS (46.72%), 84 moderate patients (36.68%) and 38 severe ARDS patients (16.59%). Among 253 meet Berlin definition patients , 49(19.77%) were mild,148(58.50%) were moderate,and 56 (22.13%) were severe ARDS. There are 204 patients that meet Zhang criteria, among the 204 enrolled patients, 87(42.65%) were ALI and 117(57.35%) were ARDS. The AUROC of the Berlin Definition, the Plateau criteria and Zhang criteria were 0.6675 (95% CI 0.5866-0.7484), 0.6216 (95%CI 0.5317-0.7116) and 0.6050 (95% CI 0.5084-0.7016).Conclusion For Xining, Qinghai, the Berlin Definition Plateau oxygenation index correction criteria can distinguish the severity of ARDS , but it needs to be enlarged and confirmed by multicenter clinical studies.

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Acute Respiratory Distress Syndrome and Prone Positioning

AACN Advanced Critical Care ◽

10.4037/aacnacc2018161 ◽

2018 ◽

Vol 29 (4) ◽

pp. 415-425 ◽

Cited By ~ 6

Author(s):

Dannette A. Mitchell ◽

Maureen A. Seckel

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Treatment Time ◽

High Morbidity ◽

Prone Positioning ◽

Positive End Expiratory Pressure ◽

Berlin Definition ◽

Length Of Treatment

Acute respiratory distress syndrome continues to have high morbidity and mortality despite more than 50 years of research. The Berlin definition in 2012 established risk stratification based on degree of hypoxemia and the use of positive end-expiratory pressure. The use of prone positioning as a treatment modality has been studied for more than 40 years, with recent studies showing an improvement in oxygenation and decreased mortality. The studies also provide evidence to support the methodology and length of treatment time. Recent guidelines include several ventilator strategies for acute respiratory distress syndrome, including prone positioning. Protocols and procedures discussed in this article ensure successful prone repositioning and prevention of complications related to the procedure itself.

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